Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1013470269 |
---|---|
Provider Name | Alex Roseman |
First Address | Drexel Hill, PA 19026-5368 |
Second Address | Philadelphia, PA 19104-1332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2019 |
Last Update Date | 12/04/2019 |